The use of health care services and psychotropic medication in a community sample of 9-year-old schoolchildren with ADHD

Abstract

To examine the prevalence of the use of health care services and psychotropic medication within a community sample (N = 283) of 9-year-old school children and, more specifically, to evaluate the use of prescribed stimulants. Data from the second follow-up phase of the "Study of Attention Deficit Maastricht" (SAM) were analysed. Assessments at age 9 included a structured psychiatric interview with parents, behaviour and family situation questionnaire, IQ estimate and global assessment scale. Use of health care services and medication was obtained by the DICA-R and from the Youth Health Care records. About 190 children of the selected sample had at least one child psychiatric diagnosis, 26 (14%) of them were clinically referred and 12 (6%) received stimulants. Of the children with ADHD (N = 45), 10/45 (22%) received stimulants. Conversely, 2 out of 12 children who were treated with stimulants did not meet full DSM-IV diagnostic criteria, but were subthreshold ADHD cases. The treatment status was highly dependent on being clinically referred. The major finding of our survey is a lack of referral to child mental health services, and associated underdiagnosis and undertreatment, particularly in children with ADHD. There is a critical need to translate and implement the diagnostic and treatment guidelines to clinical practice.